化疗前后CEA水平变化在晚期非小细胞肺癌患者疗效评价和预后判断中的价值

Serum CEA levels for evaluation of chemotherapy efficacy and prognosis in patients with advanced non-small cell lung cancer

目的探讨晚期非小细胞肺癌(NSCLC)患者2周期化疗前后CEA水平变化评价影像学肿瘤疾病控制的效能和预后的价值,为2周期后是否调整治疗方案提供依据。方法回顾性分析53例NSCLC患者化疗前、2周期化疗后血液中CEA水平变化;应用ROC曲线评价CEA水平变化对于化疗后影像学疗效达疾病控制(DC)的评价效能;探讨CEA水平变化与预后的关系。结果CEA水平变化率评价DC的ROC曲线下面积为0.794,CEA水平变化率阈值为-34.0%,此时敏感度和特异度分别为80.0%和87.5%。CEA水平变化与DC呈明显正相关(r=0.526,P<0.01)。CEA变化阳性的患者肿瘤无疾病进展时间(PFS)明显长于阴性患者(中位值分别为6.87和2.77个月,P<0.05)。CEA水平变化及化疗周期数、体重变化均是预测PFS的独立预后因子(均P<0.05)。结论在CEA水平升高的晚期NSCLC患者中,2周期化疗前后CEA水平变化可以有效评价影像学DC和预测PFS,CEA水平变化可作为影像学评价的重要辅助工具,有利于全面评估疗效。

Objective To evaluate the chemotherapy efficacy and disease prognosis by using serum carcinoembryonic antigen （CEA） levels in patients with advanced non- smal celllung cancer （NSCLC）. Methods The changes of serum CEA lev-els in 53 patients with NSCLC before and after 2 cycles of chemotherapy were retrospectively analyzed. Receiver operation char-acteristic （ROC） curve of CEA changes was used for evaluation of radiological disease control （DC）. The correlation of CEA changes with progression- free survival （PFS） of patients were also analyzed. Results When the change rates of the CEA levels were used to evaluate DC of patients, the area of ROC curve was 0.794. Using cut- off value of- 34.0%CEA level changes, the sensitivity and specificity were 80.0% and 87.5%, respectively. Correlation regression analysis revealed that CEA change was positively correlated with DC （r=0.526, P〈0.01）. Univariate survival analysis showed that the PFS in patients with CEA reduction was longer than those without CEA reduction（6.87 vs 2.77 months, P〈0.05）. Multivariate survival analysis demonstrated that CEA change was an independent factor for PFS in NSCLC patients （P〈0.05）, as wel as chemotherapy cycles and weight loss （P〈0.05）. Conclusion The changes of CEA levels can effectively evaluate DC and predict PFS in advanced NSCLC patients with in-creased CEA levels.